Current Surgical Approach in the Pathology of the Arteriopathic Predominant Diabetic Foot

Bobircă, Florin; Bobircă, Anca; Bordianu, Anca; Jauca, Cristina; Georgescu, D.; Radu, Raluca Nicoleta; Pătraşcu, T

doi:10.21614/chirurgia.113.5.625

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References 10 publications

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“… Treatment with negative pressure on wounds and diabetic foot ulcers is an effective adjunctive therapy. From the mechanism of action, it is based on the creation of an anti-inflammatory and pro-angiogenic effect, with the stimulation of the growth factors that will lead to the appearance of the granulation tissue [ 22 , 23 , 24 ]. Plastic surgery techniques cover defects in the foot’s soft tissue.…”

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confidence: 99%

The Outcome of Surgical Treatment for the Neuropathic Diabetic Foot Lesions—A Single-Center Study

Bobircă

Smarandache

Bobircă

et al. 2022

Life

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The prevalence of diabetic foot complications is continuously increasing as diabetes has become one of the most important “epidemics” of our time. The main objective of this study was to describe the appropriate surgical intervention for the complicated neuropathic diabetic foot; the secondary goal was to find the risk factors associated with minor/major amputation and good or adverse surgical outcomes. This is an observational, retrospective study conducted between 1 January 2018 and 31 December 2019, which included 251 patients from the General Surgery Department at the Dr I. Cantacuzino Clinical Hospital in Bucharest with type II diabetes mellitus and neuropathic diabetic foot complications. The surgical conditions identified at admission were the following: osteitis (38.6%), infected foot ulcer (27.5%), gangrene (20.7%), infected Charcot foot (3.6%), non-healing wound (3.6%), necrosis (3.2%), and granulated wound (2.8%). We found that a minor surgical procedure (transmetatarsal amputation of the toe and debridement) was performed in 85.8% of cases, and only 14.2% needed major amputations. Osteitis was mainly associated with minor surgery (p = 0.001), while the gangrene and the infected Charcot foot were predictable for major amputation, with OR = 2.230, 95% CI (1.024–4.857) and OR = 5.316, 95% CI (1.354–20.877), respectively. Admission anemia and diabetic nephropathy were predictive of a major therapeutical approach, with p = 0.011, OR = 2.975, 95% CI (1.244–8.116) and p = 0.001, OR = 3.565, 95% CI (1.623–7.832), respectively. All the major amputations had a good outcome, while only several minor surgeries were interpreted as the adverse outcome (n = 24). Osteitis (45.8%) and admission anemia (79.2%) were more frequently associated with adverse outcomes, with p = 0.447 and p = 0.054, respectively. The complicated neuropathic diabetic foot requires a surgical procedure mainly associated with a good outcome.

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